颅内动脉瘤围手术期颅内压监测临床价值的探讨

发布时间：2018-05-21 03:02

本文选题：颅内动脉瘤 + 动脉瘤夹闭术　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的：ICP监测作为严重颅脑损伤的重要监护手段已被广泛接受和应用,但ICP监测在动脉瘤围手术期应用的相关报道国内外较少,其临床价值有待研究。对动脉瘤夹闭术后及术前急性脑积水行有创颅内压(ICP)监测,探讨动脉瘤围手术期进行ICP监测的临床价值。方法：1.回顾性分析我科88例前循环动脉瘤患者动脉瘤夹闭术后的ICP监测资料与患者临床分级(Hunt-Hess分级及世界神经外科医师联盟(WFNS)分级)、Fisher分级、格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)及影像学等因素的关系；2.回顾性分析我科5例动脉瘤性蛛网膜下腔出血(aSAH)相关脑积水患者行脑室外引流加脑室内ICP监测的临床资料,并进行文献复习。结果：(1)ICP监测值与Hunt-Hess分级、WFNS分级、Fisher分级、ICP增高时GCS、术后影像学特点(基底池情况、中线移位)、术后6个月的GOS存在相关性；(2)有少数(12例,13%)患者出现意识障碍加深、影像学提示术区血肿、中线移位、基底池受压等改变,但ICP始终正常。(3)对于临床分级高的aSAH相关急性脑积水患者,脑室外引流加ICP监测不能明显改善临床表现。结论：自发性蛛网膜下出血患者行动脉瘤夹闭术时植入ICP探头并术后持续动态监测ICP能指导动脉瘤术后的治疗；同时ICP监测还需结合患者临床表现及影像学进行综合分析,以提高围手术期的安全性。aSAH相关的急性脑积水可行脑脊液外引流术,但应维持ICP稳定,预防动脉瘤破裂和颅内感染。
[Abstract]:Objective: ICP monitoring as an important monitoring tool for severe craniocerebral injury has been widely accepted and applied, but the application of ICP monitoring in the perioperative period of aneurysm is less and its clinical value remains to be studied. Invasive intracranial pressure (ICP) monitoring after aneurysm clipping and preoperative acute hydrocephalus is performed to explore the perioperative period of aneurysm. Clinical value of ICP monitoring. Methods: 1. retrospective analysis of ICP monitoring data after aneurysm clipping in 88 patients with anterior circulation aneurysms and patients' clinical classification (Hunt-Hess classification and world neurosurgeon Union (WFNS) classification), Fisher classification, Glasgow coma score (GCS), Glasgow prognosis score (GOS) and imaging A retrospective analysis of the clinical data of 5 cases of aneurysmal subarachnoid hemorrhage (aSAH) related hydrocephalus (aSAH) related hydrocephalus patients with cerebral hydrocephalus and ICP monitoring in the brain, and review the literature. Results: (1) ICP monitoring value and Hunt-Hess classification, WFNS classification, Fisher classification, GCS, and postoperative imaging characteristics (basal cistern) There was a correlation between GOS and 6 months postoperatively; (2) there were a few (12, 13%) patients with a deepening of consciousness disorder, imaging hints of hematoma, midline displacement, basal pool compression, and other changes, but ICP was always normal. (3) for patients with high clinical classification of aSAH related acute hydrocephalus, external ventricular drainage plus ICP monitoring could not be significantly altered. Clinical manifestations. Conclusion: ICP probe implantation and continuous dynamic monitoring of ICP after operation of spontaneous subarachnoid hemorrhage in patients with spontaneous subarachnoid hemorrhage can guide postoperative treatment of aneurysm, and ICP monitoring should be combined with clinical manifestations and imaging to improve the safety of.ASAH related acute cerebral accretion during the perioperative period. Water is feasible for external drainage of cerebrospinal fluid, but ICP should be maintained to prevent aneurysm rupture and intracranial infection.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.12

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